Just a few highlights from the OB-GYN-L list, in a thread dated last October, “Birthplans and Expectations”. Most of the posts can be found here.
In this thread, OBs discuss amongst themselves the issue of women forming their own birth plans. (Quelle horreur!)
Easily panicked control-freak Steven Richman opened the proceedings:
hello listers…….very busy day today and last pt. presents me with her “birth plan” at 36 weeks. The plan was entirely reasonable and certainly within the scope of how we practice……As I was tired and she was only 18, I kinda freaked and told her that we would not honor the plan and that the Dr/pt relationship requires mutual trust etc. etc…. With over 20 yrs of experience I truly feel I have gone along with the ebb and flow of obstetrical practice and procedure …….But I object to being put in a position where the “well-informed customer” feels it necessary to dictate the mode of operation.
How would you have responded to Richman? Here’s what some of his colleagues said:
My ideal birthplan:
The patient chooses the color of the baby’s room and the baby’s name.
I use the Ontario ANC record and it has a check item “Birth Plan”. When I reach the item I say “We don’t do that here.”, tick it off and move on.
When patients ask me how I feel about a birth plan, I tell them the best birth plan I can think off is that the birth will be a happy occassion for everyone involved and will result in the birth of a healthy baby; then i tell not to be to be to uncompromising and inflexible in thier expectations as they are just setting themselves up for disapointment and feelings of having failed.
El are you saying there may be a corelation between the worsening perinatal mortality rate in the U.S. and the proliferation of birth plans, you may be on to something, someone should do a randomized controlled clinical trial.
I’ve always seen the downside of birth plans to be that anything a patient expressly wished to avoid would be by a fluke of nature absolutely necessary during her delivery. It’s like the stars line up against them and our attempt to meet their expressed needs.
Louana, a midwife:
I think, IMHO, that the point of the birth plan is being missed in this conversation. Hospital routines and how they are applied in the L&D unit in many places put women in the position of being treated like an object without choices or rights. Essentially the birth plan, although it looks like something else with it’s check lists and all that, is a request to be treated like an individual and give the parents the respect that the miracle of their own individual bringing a child into this world deserves.
Dr Anna Meenan:
I would not look on it so much as “dictating the mode of operation” as expressing her preferences for the way she hopes the most important event in her life will be allowed to proceed. I find that quite reasonable and wonder why anyone else wouldn’t, especially if the plan was quite reasonable and well within the scope of your practice. You speak of mutual trust. Does that mean she must trust you to know what her preferences are? Most docs I know do not have ESP. I wonder, if her birth plan called for induction at 39 weeks, early amniotomy, high-dose pitocin, forceps, and a midline episiotomy, would you accuse her of dictating the mode of operation?
Eberhard Lisse, responding to Dr Meenan:
Blah Blah Blah.
Sue, a midwife, replied:
Translation-I do no have respect for you enough to listen to your wishes, try to accommodate them and help/encourage you (to do what your body does naturally on its own, big secret)to do one of the most important things in your life in a way that you desire. Oh and by the way, thanks for choosing me and paying me to care for you!! Flame away.
The response from Eberhard Lisse?
Hey, isn’t it dangerous to fly a broomstick with poor eyesight?
These are mostly USAn contributors, but I can state from experience that the attitudes amongst my colleagues here follow a similar range. Some accept that women have bodily sovereignty, even embrace the idea; many don’t. And you can’t tell by looking at them.
So. Yeah. Pregnant readers: you might want to have an in-depth chat with your care provider about their attitude to you having control over your own body.